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Sparks Chiropractic LLC

Clinic/Center in Portland, OR. Organization (NPI-2).

NPI number1982247698
StatusActive
Last updated in NPPESDec 9, 2019

Details

NPI
1982247698
Entity type
Organization (NPI-2)
Legal business name
Sparks Chiropractic LLC
Organization subpart
No
Enumeration date
Oct 25, 2019
Certification date
Dec 9, 2019
Last updated
Dec 9, 2019

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261Q00000X Clinic/Center––Yes

Practice location

11125 Ne Sandy Blvd
Portland, OR 97220-2555

Phone 503-257-3377 · Fax 503-257-3432

Mailing address

11125 Ne Sandy Blvd
Portland, OR 97220-2555

Phone 503-257-3377 · Fax 503-257-3432

Authorized official

Beau William Sparks
Chiropractic Physician
5032573377

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